Six-Month Mortality Lower With Liberal Transfusion Strategy in Acute MI With Anemia

MONDAY, Jan. 6, 2025 (HealthDay News) — For patients with acute myocardial infarction (MI) and anemia, the primary outcome of 30-day mortality or MI does not differ with a restrictive versus liberal transfusion strategy, but a restrictive transfusion strategy is associated with increased all-cause mortality at six months, according to research published online Dec. 23 in NEJM Evidence.

Jeffrey L. Carson, M.D., from the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, and colleagues examined the effect of restrictive versus liberal blood transfusion strategies in patients with acute MI and anemia. Patients were randomly assigned to a restrictive (transfusion threshold of 7 to 8 g/dL) or liberal (transfusion threshold of 10 g/dL) red cell transfusion strategy; data were included for 4,311 patients from four trials.

The researchers found that the primary outcome (composite of 30-day mortality or MI) occurred in 15.4 and 13.8 percent of patients in the restrictive strategy and liberal strategy groups, respectively (relative risk [RR], 1.13; 95 percent confidence interval [CI], 0.97 to 1.30). Death at 30 days occurred in 9.3 and 8.1 percent of patients in the restrictive and liberal strategy groups, respectively (RR, 1.15; 95 percent CI, 0.95 to 1.39), while cardiac death at 30 days occurred in 5.5 and 3.7 percent, respectively (RR, 1.47; 95 percent CI, 1.11 to 1.94). No significant difference was seen in heart failure between the transfusion strategy groups. All-cause mortality at six months occurred in 20.5 and 19.1 percent of patients in the restrictive and liberal strategy groups (hazard ratio, 1.08; 95 percent CI, 1.05 to 1.11).

“Giving more blood to anemic patients with heart attacks can save lives at six months,” Carlson said in a statement.

Abstract/Full Text (subscription or payment may be required)